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Energetic Exhalations and the Miasma of Complications
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There are many ways of making the coronavirus epidemic complicated. It is true that the Chinese account of what happened may be deficient, and that the numbers of deaths are probably underestimated. It is true that as each country received cases from China at somewhat different times and in different numbers it then went through its own particular epidemic, so comparing countries is subject to a timing bias.

Nonetheless, countries have their uses: they can close borders and establish a set of procedural rules and, to varying extents, implement them. This provides comparisons: will European countries do better than Taiwan, South Korea and Singapore? Will Sweden do better than the rest of Europe in terms of human cost vs lockdown cost? Are deaths per million the best comparison?

Complications arise because death comes with several precipitating causes, and death certificates must determine which of those finally finished the person off. John Graunt was aware of all these problems in 1662 when he published Natural and Political Observations Made upon the Bills of Mortality, thus launching demography and, at a very broad level, epidemiology. He made an astounding contribution. Here is a comparison I did of lifespans in his time and at the Millennium (shown for women only because I was discussing breast cancer).

As you can see, the population studied by Graunt began to thin out progressively from an early age. A few lived to the current lifespan, but nothing like the numbers of those alive today. An unrestricted pandemic would push us down somewhat, possibly similar to smoking being taken up again in large numbers.

Currently, dying “with”, but not “of” prostate cancer is a case in point as to the vagaries of classification, and the same applies to coronavirus as a cause of death. It is a bit like classifying deaths from influence A and B separately. To get round the problem of attribution, tracking excess deaths against seasonal averages is a good way of estimating what the real contribution of the pandemic may be.

A further complication is that it is hard to calculate how many people in the general population have been exposed to the virus. To do that properly, one would need a large random sample, perhaps 16,000, a highly accurate test, and a criterion group of previously infected patients, say 600 of them. Every test has an error term, even those touted as being very accurate. Even when it is trained on a criterion group there will be less than perfect sensitivity and specificity. Some of the signals the test picks up are ambiguous because they are borderline on a useful dimension, others can be misleading because an anti-body can have been triggered by other infections.

Then, when the test is used on the general public, the base rate problem rears its head. Small error rates in a test become very important when the disorder being tested for is rare. Population screening for breast cancer is an example. False positives are common, and are tolerated by doctors, if not so willingly by patients. Commonly, the chance that a positive test means that cancer is actually present may be only 10%. 9 patients get alarmed and are investigated for every one case found.

Some people react to all these complications by throwing up their hands and bemoaning that little is known about the virus. I demur. These are complications, but not fatal to drawing some preliminary conclusions. For example, this virus is not a Black Swan. It is yet another White Swan. (Strange as it may seem, I agree with Nassim Nicholas Taleb on this point). Much of what is known about coronaviruses applies to this recently encountered one. The contagion/fatality space is reasonably well known.

As a corrective to all these complications, here is a simplified version of the pandemic we face, and some possible solutions. It is intended to be simplistic.

It boils down to 2 factors: the viral load a person receives, and their immunological status.

Immunological status is particularly poor in old, ill and fat men. Shielding them would be a kindness, and should not require younger and fitter persons to be kept in idle captivity. The young shall inherit the earth, and the old will hold on to the capital, for the time being at least, as they dole it out to the young. Most of the elderly will survive, so long as they are not exposed to high viral loads.

Lockdowns provide a breathing space, reduce peak hospital demand, and temporarily diminish risks of infection for everyone. Any treatment intervention that saves lives (lives that the survivors themselves want to live) is to be welcomed, but it is more important to reduce viral loads in the first place.

High viral loads come principally from globules sprayed out by infected persons, as they sneeze, cough or in any way breathe heavily; secondarily from aerosols emitted by the same processes, least of all from either of these droplets lodged on surfaces. Getting from donor-nostril to recipient-nostril is the royal road for the virus. Energetic exhalations are the problem, hence dancing and singing and heavy exercises all create sprayed teaspoons full of goo which get breathed in by other people. Crowded and poorly ventilated rooms where such energetic activities happen create an infectious miasma. Sitting quietly in a room is less dangerous, and walking in the open air least dangerous of all, unless a succession of panting runners keep thundering close by.

When judging any activity, look at the distance between persons in still air, and estimate the degree of energetic exhalations. Clearly, wearing masks in enclosed places cuts down the spray of snot from the sneezer and the amount breathed in by the sneezed-upon. Any fabric will provide some reduction, N95 respirators a much greater reduction. Go the whole way and get a close-fitting neoprene mask with two permanent filters bolted on, and an escape valve so that you can breathe out directly, and the result is comfortable and effective.

In sum: wear facemasks when close to others in any confined space; provide good ventilation in all public buildings; and take part in plenty of open-air activities.

 
• Category: Science • Tags: Coronavirus, Disease 
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  1. “Top doctor” dies.

    under unbearable stress, a medical director of NewYork-Presbyterian Allen Hospital’s emergency department, committed suicide. from nycCoronavirus

    This story looks like a fake. Look at the picture of the alleged Dr. Breen. The head is pasted on. The skin color is off, and the size. Imagine the picture as a video. Visualize that giant head bobbling around. Dr. Bucket Head. She looks young for 49, given that she must have been depressed for many years, likely abusing alcohol and medications, and would not have looked this good.
    If the picture is fake we can assume the rest is too. How did “she” (do photoshop people have gender?) get from NYC to Charlottesville? Whether by car or plane, it is a grueling day, and as an MD she should have thought about all the people she could infect. Like her sister and her family. Dr. Breen must have missed “Infectious Disease 101” at medical school. That is how “top doctors” roll. We are told she was sick with Covid 19, sent home, returned to work, was reinfected and sent home again. At which point she elected to travel. A quick search for her father found only links to this story. Strange. After a full career in medicine it is odd that Google found no reference to Dr. Philip Breen. He does not appear to be still practicing and most doctors, upon retirement make some news, even if it is a local newspaper or medical newsletter. It’s doubtful he is a real person.
    But facts are irrelevant here, as this piece plays entirely to emotions. Dr. Breen was traumatized (as much as pixels can be) by the flood of patients, with some found dead in the ambulances. At those sleepy NYC hospitals you can find plenty of citizen videos of, all ghost towns. But she liked to snowboard and play the cello. Very cogent facts the reader needs. They must have left out that she loved puppies, kittens and ponies. The important information here, the reason for the fakery, is that she died after being reinfected. Covid19-2.0. This is crucial to the narrative that this “plandemic” is not going away. Spun from whole cloth, it has an unlimited duration and can revisit at any time. Providing the pretext to continue or reimpose the “lockdown” (I thought only convicts got “locked down”?) whenever they please.

    Why this is being staged? Breakdown in US/China trade term? Oil market madness? Cover for a new round of bailouts? Something huge is going on behind the scenes, and it has nothing to do with viruses.

    • Replies: @Tusk
    , @VICB3
  2. Well, the undetected can be seen. Here is my latest update on Wales, now home to the UK top two most heavily infected hospital boards, Cwm Taf Rhondda having overtaken Brent in London for 2nd place. The population is elderlt, poor and more overweight than most.

    Surfaces are important. Aerosols breakdown in air. One a non absorbent surface the virus survives with a much longer half life.

    MEanwhile, a Chinese maufacturere has offred me a graphene mask. Graphene, a Russo-British invention, can filter very fine particles, much finer than FFP2 or even 3 and allegedly kills viruses. I’d like it if masks were more effective. I could sell them.

    Masks are being made compulsory on public transport (-buses) in Zambia and advisory for travel in some Russian provinces that I know of. I have mask making machines on offer too. No one actually seems to believe that this will last long enough to be worth the investment and/or they hesitate to compete with China.

    • Replies: @Philip Owen
    , @The Alarmist
  3. Your advice here is good, for the immunologically compromised, those with comorbidities, those on medications.

  4. Mr. Graphomania is a China-did-itter and wants old people to die. What are charming and credible saint of a man.

  5. @Philip Owen

    Sorry about that typing. Glaucoma meets dyspraxia. I literally don’t see it.

  6. @Philip Owen

    Be cautious with the ONS stats. I queried ONS, and they confirmed, that the COVID-related death count stats may also be counted in other categories, e.g. Death from All Respiratory Diseases. The COVID stats count cases where COVID is merely mentioned on a death certificate and does not necessarily mean it was the primary cause of death.

    • Replies: @Philip Owen
  7. To get round the problem of attribution, tracking excess deaths against seasonal averages is a good way of estimating what the real contribution of the pandemic may be.

    The signal is further complicated with a lot more noise introduced by the lockdown, to wit, fewer traffic fatalities, more suicides, more deaths from untreated medical issues, etc. Plus, keeping us locked down limits our exposure to the small loads of pathogens we normally get every day out in the world with others and which keep our immune systems on their toes.

    It will be interesting to see data a year on to see if what we are now calling “excess” deaths is actually a pulling forward of what were going to be premature deaths anyway a few months to a year down the road due to the comorbities at play in most cases.

    The UK ONS stats show a huge culling at the top ages. One can only wonder what the Continuous Mortality Investigation of the Faculty of Actuaries will do to massage their next round of mortality improvement-rate estimates, which they have doggedly resisted revising significantly downward since 2011 on the assumption that we would revert to the improvement trends we saw prior to 2011, which curiously showed improvements slowing down considerably right after the last big financial crisis.

    • Replies: @Hail
  8. @The Alarmist

    This is why I thought coverage of Wales needed to track All Causes deaths to look for over or under reporting of CV19. CV19 has seemed to be slightly over reported, if anything, in Wales. All causes mortality less CV19 has been slightly down on previous years. Mind you, Emergency Admissions to hospital are down 60%.

    Wales contains the two hottest hot spots in the UK by hospital board. I live in one (Two weeks ago it was fine but it finally broke into several old people’s homes). Brent is 3rd. A plot by population density shows a clear correlataion with population density. I haven’t seen plots for obesity rates, age or race. The plot is below. I don’t expect you to relate to the names of the local authorities but the trend in there. Cardiff was off the scale, as in made the others invisible.

    This hypothesis predicts that Istanbul, Moscow, and St Petersburg will have the worst rates of infection in Europe. People live in flats in the Randstadt but it is quite spread out. Paris has flats but quite low rise.

    • Replies: @The Alarmist
  9. dearieme says:

    It seems to me that one important aspect of the plague is the way that asymptomatic people spread it so easily: this will make test-and-track policies almost impossibly difficult if the disease is becoming widespread. Moreover, not only would accurate tests be desirable, you really want them to have a fast turn-around – e.g. result available in half an hour? – and so cheap, and so easily applied, that you can test large numbers of people a couple of times a week. Why, that might even allow governments to do a bit of random sampling to see how widely the virus has spread.

    And a question: I recently saw it said that nobody yet knows whether children are good or poor spreaders of the virus. I’d have thought that that would be worth knowing: they don’t themselves suffer from serious symptoms but can they bring it home from school to Mum, Dad, and Grannie?

    • Agree: Philip Owen
  10. Sean says:

    Plus, keeping us locked down limits our exposure to the small loads of pathogens we normally get every day out in the world with others and which keep our immune systems on their toes.

    That is an excellent observation and new to me. It is a telling one in support of the idea there is going to be a wave of deaths when the lockdown comes off. Although the the government are probably not taking that additional multiplier into account, they are surely already dreading the deaths that will follow from COVID-19 and other mortality bounceback.
    —-

    In sum: wear facemasks when close to others in any confined space; provide good ventilation in all public buildings; and take part in plenty of open-air activities.

    It is more difficult to catch it outside but in my opinion, very far from unlikely you will even while just walking past someone on a non broad pavement when you are in many cases forced to step into the road or have them breathing in your face especially if they are talking on a phone or to a companion. I don’t think being outside is all that safe at all when you are walking through choke points with loungers and someone coming in the other direction so you are forced to be in respiratory aerosol range.

    There are joggers huffing and puffing (even sometimes spitting) as they run along pavements and they do not stay. Some countries have banned that. A lot of ordinary pedestrians coughing today with a little cold spell.

  11. Sean says:

    NotAProfessor {K}nut Wittkowski’s latest interview, I think he has been hauled over the coals, he looks shell shocked.

    Wittowski’s suggestion that old folks and nursing homes homes should have been isolated totally with live in staff paid massive overtime for staying there makes a lot of sense. Also interesting when he talks about, or rather refuses to talk about because it concerns a homogenous hypothetical population, the R0 value affecting the percentage of a population at which herd immunity is reached.

    • Replies: @Hail
    , @obwandiyag
  12. Hail says: • Website
    @The Alarmist

    a lot more noise introduced by the lockdown, to wit, fewer traffic fatalities, more suicides, more deaths from untreated medical issues, etc.

    It has been confirmed that a large share of excess deaths in the UK were coronavirus-negative, and that only a small share of excess deaths (<15%) were attributed primarily to COVID19.

  13. Hail says: • Website

    Dr. Thompson wrote:

    The contagion/fatality space is reasonably well known.

    COVID19 fatality rate: 0.7%- 3.4%

    When is this data from?

    I don’t think anyone in the world claims anything as high as 3.4% anymore. That was media fearmongering driven primarily by innumeracy — [Deaths]/[Confirmed Cases] — which dates back to February and is long discredited by April, and was untenable even by mid-late March, afaict.

    Even an order-of-magnitude downward revision, to 0.34% is, at this point, too high; if we go by the data, the comprehensive randomized studies from all over the US and Europe, the more likely order of magnitude for a Wuhan Coronavirus infection fatality rate is indeed 0.034%.

    _____________

    Here is a question I haven’t seen asked: What is the fatality rate is for those who have a treatable health-emergency during a Lockdown/VirusPanic? We know it is higher due to those dying who were too terrified, by the media-drumbeat and the extremist shutdowns, to seek treatment. What would be sadly ironic (and to pro-Panic Neil Ferguson’s eternal shame) would be if this latter fatality rate were above the true COVID19 fatality rate (of ca. 0.1%), which I think evidence points to being the case. Granted, you’re quickly in a definitions game of what is a health emergency.

    What percentage of UK heart attacks were fatal in 2019? What percentage are fatal during the UK’s Corona-Lockdown?

  14. To get round the problem of attribution, tracking excess deaths against seasonal averages is a good way of estimating what the real contribution of the pandemic may be.

    “excess deaths”
    Hospitals across the US are canceling procedures to make room for a potential surge of coronavirus patients

    US hospitals postpone non-emergency procedures amid coronavirus pandemic

    California health providers postpone elective surgeries to prepare for coronavirus surge

  15. @The Alarmist

    Yes. Especially in Russia. They are tiny. People do take the stairs as far as the 7th floor but the stairs are almost as bad.

  16. VICB3 says:
    @Thomas Milton

    Some thoughts:

    – There’s a Dr. Philip C. Breen, MD in Mcconnellsburg, PA 17233. Probably her father.

    – Mother, an MD as well, lives in Charlottesville VA, and nowhere near Mcconnellsburg PA

    – A Google image search shows plenty of pictures of her in group shots with, probably, relatives. Lots of shots with other women. Bobblehead or no, that’s really her.

    – No apparent man in her life based on the photos. Couldn’t find love? Closeted lesbian in conflict with her religion? Hmmm.

    – The parents are probably divorced.

    – Highly educated, highly driven, and probably with a high IQ, and the offspring of similar type parents, she was always too tightly wound for her own good.

    – “Devout Christians” are very often too tightly wound as well. (Usually become born again after a critical and negative incident in their lives. Usually they’re hiding from themselves. Have lost track of the number Devout Chiristians and their families encountered with major skeletons in the closet or things to hide.)

    – The two above points taken together would indicate that she’d probably always been unbalanced. Chronic psychosis from lack of sleep – those 12 hr shifts – wouldn’t help either.

    – The booze and pills thing is probably correct.

    – There was something under the surface. Plenty of other doctors have seen the same things and they haven’t topped themselves.

    – Probably was off her rocker, but nobody wants to flat out say so, speaking ill of the dead and all that.

    – Agree with the whole puppies and kittens and ponies eulogy that’s too good to be true.

    – Agree that the hospitals are empty, so in that regard the whole stress from masses of infected patients hacking and gagging their guts out in the hallways storyline is so much B.S.

    – Agree that this story is waaaay too emotional.

    Just a thought.

    VicB3

    • Replies: @Sparkylyle92
  17. All your babble about statistics is all wrong. I have seen statistics supporting all sides and then some. You just cherry-pick the one you want, or massage the data, or spin it, or, like a data marketer I used to know, whatever the results of her survey, she just told her bosses whatever she felt like. I mean, they don’t know what the Greek letters stand for, so, what the fuck.

  18. @Sean

    The nursing home racket in the US is an enormity of outrageous proportions. After we string up the rich people, we go after the nursing home administrators.

  19. joe2.5 says:

    High viral loads come principally from globules sprayed out by infected persons, as they sneeze, cough or in any way breathe heavily; secondarily from aerosols emitted by the same processes, least of all from either of these droplets lodged on surfaces.

    Thanks for the accurate summary of the situation.
    Reviewing some of the available analyses of patient tracking in the community (ie not airports or transit), though, it seems that they come up with over half of the cases where the investigators were unable to find a plausible encounter with another patient. That might suggest that aerosol is in fact the principal way of transmission. What is known of the behavior of aerosols, sometimes hanging in the air long after the emitter is gone, sometimes travelling far, supports this. Also see the letter by Dr. Wathelet (English translation offered by PC Roberts here under “Coming Out of Lockdown Unprepared”)

  20. Anne Lid says:

    Just wanted to let you know that I posted the article on my farcebook page with a short quote, and it cannot be displayed anymore, because the “post goes against our Community Standards”.

    • Replies: @James Thompson
  21. @Anne Lid

    Yes. We have been cast out. A nuisance.

  22. @VICB3

    If you do a google search on her name and click images, you only find 3 or four independent pictures. And they’re all fake. It’s a hoax all right.

  23. Odds that the Wuhan coronavirus will be one of the top ten stories of the 21st century are near zero.

    There are three or four revolutions that the younger people on this thread will probably experience.

    The end of our patience with the current overlords will be a big story, but no bigger than the move from an Eisenhower America to an Obama America, or a 1962 England to a 1972 England.

    I am guessing the world will have zones in 50 years that will follow lines that are not exactly clear right now, but anyone can understand what is likely to happen if they just think about the difference between the 2020 version of Bill Gates and a future person similar to Bill Gates but without the unempathetic nerdiness, without the needy desire to appear up to date, and without the residual stupidity. Transitioning from our world to a world with such zones will be a bigger deal than the coronavirus.

    I am also guessing that the internationalists who supported the Wuhan lab, and the clumsy CCP who made it worse, will be pikers compared to the next iteration of catastrophic bunglers.

    I could go on …. but while I am a Christian, I am not a prophet. Also, under almost all likely versions of actuarial facts, I will only live for the next 15 years or so at most, and while I care about younger generations, I really do not have the same stake in this as they do. If I did, I would be a little more blunt, but it does not matter what I say. If my guesses are right, it makes no difference if I say them out loud, and I am certain that there are many people who know what I would be saying if I were going to say it, many of them much much younger than me.

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